If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
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E-letters: Electronic letters published:
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needle distal part attack the nerve -that is the target
- Mahamoud M Gabal, Mahamoud M Gabal (8 May 2006)
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How can they control the needle ?
- Hannes Gruber (23 November 2005)
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Short vs Long Probe Axis
- Stephen A Roberts, Clare Roques (4 August 2005)
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Mahamoud M Gabal, radiologist , Mahamoud M Gabal
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Indeed I read these letters and I share the same questions regarding the use of ultrasound in regional anaesthesia -long distanse or short distance ? Our target, however, is not to see the entire length of the needle. We need to concentrate on the tip of the needle in its way to the nerve. You can do this in several ways. First you can insert the needle between transverse and longitudinal approach. Second you can put a thick layer of gel and angulate your probe on it while the needle is in more or less vertical postion to the target nerve. Third, the fact is that more superficial and more central the postion of the target nerve, the more distance requires to be travelled by the needle, and to overcome this problem you can try to put the target at the prephery of the picture and then you will need the distance to travel midway between the long and short distances. Fourth - another fact that the more deep the target the less the resolustion of the picture by high frequency probes however the linear probes with the less frequency are more optimal to this approach or you have to wait for the tip of the needle to appear in your field in using curved probes. Finally it is amatter of tranning and gaining experience by trying to do it using models.
Conflict of Interest:US models |
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Hannes Gruber, Radiologist Clinics of Radiodiagnostics, MUInnsbruck
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With much interest I read this paper which is basing on very good and innovative ideas (as always in this group). Still disappointing (also compared to previous papers of this group) is the fact that they still do their infiltrations under sonographic control and not sonographically guided. In several papers of this group it is striking that they vehemently refuse to scan their structures of interest (including any injection-needle percutaneously inserted) longitudinally which resulted in a really guided situation due to a "real time" depiction of the complete situation. As proposed the authors can never be sure (see figure 3) whether they depict the tip or another part of a needle (with probably the needle tip already intra-peritoneally!) which might be harmful. I hope for surely very innovating further studies properly guided sonography will be applied. Conflict of Interest:None declared |
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Stephen A Roberts, Consultant Paediatric Anaesthetist Jackson-Rees Department of Anaesthesia, Alder Hey Hospital,Liverpool, UK, Clare Roques
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Dear Editor Dr.Willschke and colleagues are to be congratulated on their paper. They describe their technique with the needle crossing the short axis of the probe; this has the advantage of familiarity to anaesthetists, the same needle-probe technique is used for ultrasound guided central venous access. However, the needle tip can not always be visualised. We find having the probe in the same position described but with the needle crossing the probe's long axis (medial to lateral) a more controlled method as the needle can be seen throughout insertion, and as quite clearly demonstrated the peritoneum is extremely close. With experience it becomes easy to see these small nerves reliably, whilst learning a reliable block can be achieved even if the nerves are not imaged by ensuring the needle tip is positioned in the plane between transversus and internal oblique. Conflict of Interest:None declared |
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